PC1024: Factors Associated with Inconsistent Condom Use Among Female Adolescent Emergency Department Patients

Background: Inconsistent condom use increases the risk of sexually transmitted infections (STIs). Over 18 million adolescent and young adults (AYA) seek care in the emergency department (ED) each year, many of whom present for diagnosis and treatment of STIs and use the ED as a primary location of medical care. Despite females being active participants in the condom decision-making process, little data exists exploring condom use among female AYA in the ED setting. We aimed to assess the prevalence of and demographic, behavioral, and knowledge-based factors associated with inconsistent condom use amongst sexually active female adolescent ED patients.

Methods: We performed a secondary analysis of baseline data from a prospective randomized controlled trial of a mobile health pregnancy prevention intervention in an urban pediatric ED. Included were female patients aged 14-19 years who were sexually active with males, did not want to become pregnant in the next year, and were not currently using hormonal contraceptives. Participants completed a baseline questionnaire. We defined inconsistent condom users as participants who answered that, over the past 3 months, they used condoms during sexual intercourse most of the time, half the time, some of the time, or none of the time. We used a validated condom quiz to assess condom knowledge. We performed univariate logistic regression analyses and t-tests to identify factors potentially associated with inconsistent condom use.

Results: We analyzed 143 participants, 84% (120/143) of whom used condoms inconsistently. Table 1 displays that those females who used condoms inconsistently were more likely to have been younger at first sexual intercourse and ever used highly effective contraception and/or emergency contraception before. While 18% (22/120) of those using condoms inconsistently had a history of pregnancy, none of those using condoms consistently had a history of pregnancy. Average scores on the condom knowledge quiz did not vary based on condom use (score for consistent condom users was 9.7/12 +/- 1.4 versus 9.7/12 +/- 1.6 for inconsistent condom users).

Conclusion: The majority of sexually active female adolescents in this study, despite having primary care doctors and condom education, were using condoms inconsistently, particularly those who ever used a hormonal contraceptive and/or an emergency contraceptive before, or experienced sexual intercourse at or before age 15 years. Future interventions to increase condom use and decrease STI risk should consider focusing on this high-risk, vulnerable population.